Vertebral Fractures

Back pain may be an indication of a stress fracture known as a vertebral compression fracture. Vertebral compression fractures occur when the normal vertebral body of the spine is squeezed or compressed to a reduced height. The bone collapses when too much pressure is placed on the vertebrae, resulting in pain, limited mobility, loss of height and spinal deformity. In very severe compression fractures, the back of the vertebral body is pushed into the spinal canal and pressure is placed on the spinal cord.

Vertebral compression fractures can occur as a result of trauma from a fall, a forceful jump, a car accident or a tumor that spreads to the spine from elsewhere. Vertebral compression fractures are usually caused by osteoporosis, a condition that causes thinning of the bone. The thinned out bones can cause tiny fractures during normal activities. In severe cases of osteoporosis, a simple movement, like bending forward, can cause a spinal compression fracture, resulting in kyphosis, a hump-like curvature of the spine.

The most common symptom of vertebral compression fracture is severe pain in your back, which worsens on standing or walking, and decreases on resting. You may also feel weakness and numbness in the affected areas, disability, and limited spinal mobility. You may also notice a loss of overall height. Patients who sustain multiple compression fractures may have kyphosis or "dowager’s hump", gastrointestinal problems, hip pain and shortness of breath.

Your doctor will carefully examine you based on your symptoms and medical history. Your doctor may also recommend diagnostic tests such as:

• X-ray: A spinal X-ray may be taken to determine the presence of a fracture.
• MRI scan: An MRI of the spine may be ordered to determine if the fracture is old or new, and detect other soft tissue abnormalities.
• Bone scan: A nuclear bone scan may be ordered to help determine the presence or age of the fracture.
• DEXA scan: Dual-energy X-ray absorptiometry scan is a test that measures bone mineral density, and is typically used to diagnose osteoporosis.

Treatment

The treatment for vertebral compression fractures aims at reducing pain, and stabilizing and repairing the fracture. This is best achieved with medication, back braces, bed rest and physical therapy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to relieve bone, muscle and nerve pain. Your doctor may prescribe a back brace that supports the back and restricts movement.

Surgery may be needed in patients who continue to have severe pain despite nonsurgical treatment. Your surgeon may suggest one of the two minimally invasive surgical procedures for treating vertebral compression:

• Kyphoplasty: In this procedure, a large needle is introduced into the spine with a balloon, called a bone tamp, and inflated until it expands to the desired height. The space created is then filled with or injected with orthopaedic cement called polymethylmethacrylate (PMMA). This procedure restores the height of the vertebra and reduces the deformity.
• Vertebroplasty: This technique involves inserting a cement material called polymethylmethacrylate into the bone of the collapsed vertebra with a needle, under the guidance of X-ray. This technique is performed in order to stabilize the fracture and prevent further collapse.

Prevention

The most effective way to prevent vertebral compression fractures is to prevent osteoporosis. A well-balanced diet, regular exercise program, calcium and vitamin D supplements, smoking cessation, estrogen hormone replacement for women, and practicing good posture may help you to prevent osteoporosis.